Insomnia and disrupted sleep are some of the most common complaints Americans present to their doctors. A recent study from the University of Pennsylvania determined that 25 percent of Americans will experience an acute episode of insomnia within the course of a year. A further 25 percent of that group will then proceed to develop chronic insomnia which may last for years and negatively affect health in many ways.
The importance of sleep is obvious to anyone who has ever missed a single night of slumber. While many aspects of our sleep architecture and phases are poorly understood, we have clearly established the role of sleep on the daily metabolic maintenance and detoxification our bodies require. These fundamental functions of the human body are needed to achieve optimal health and pull us away from the depths of disease.
Sleep aid medications have been available for decades but can come with undesirable side effects, most notably the cycle of dependence and withdrawal. Finding new and natural methods to recalibrate this important system and achieve sound sleep should be a top priority for all health-care practitioners.
Your Natural Rhythm
Circadian rhythm is arguably the most important bio-rhythm we possess. It is responsible for keeping us alert and awake during the day as well as relaxed and asleep during the night. This rhythm is controlled by the secretion of and interaction between melatonin and cortisol hormones. Melatonin dominates the relaxed/asleep/night hours and cortisol dominates the alert/awake/day hours. While there are many contributing factors for insomnia, disruption in the circadian rhythm is a leading cause.
Due to their swift effect, prescription pharmaceuticals can be a tempting way to get a good night’s sleep. Many of these drugs, such as benzodiazepines like Valium and Xanax or hypnotics like Ambien, are sedatives that rapidly impact the brain’s GABA receptors to induce sleep. GABA is the primary calming neurotransmitter in the human brain and has a balancing effect on the activating neurotransmitter glutamate. A healthy circadian rhythm will support increased GABA production prior to going to sleep. Unfortunately, increased GABA production can be a strong force to some individuals and hence lead to tolerance, dependence and even addiction. In addition, the sleep produced from these agents does not replicate the natural sleep phases and architecture that is so important for restorative sleep. In the long term, this is not a solution for chronic insomnia.
Lifestyle habits can interfere with sleep. It is possible to improve sleep quality with some specific adjustments to the sleep environment also known as good sleep hygiene.
- Meal timing. Do not eat a full meal within 2-3 hours of going to bed. A gut full of food will force your body to redistribute resources to digestion when those resources are most needed for daily maintenance and detoxification.
- Electromagnetic fields (EMF). EMFs radiate from Wi-Fi routers, smartphones, cordless phone bases, outdoor cellular antennas and a disturbingly growing array of household appliances. Some easy interventions would be to place your phone in airplane mode at night (or better yet just turn it off and rest) as well as turning off your Wi-Fi router when going to sleep.
- Light. We evolved to wake up to a blue-white sky and fall asleep in the dark with an amber-red fire. Keep your bedroom dark. If outdoor streetlights are intrusive, try blackout curtains. The white-violet-blue end of the light spectrum suppresses melatonin production, allowing cortisol to remain high when it should be dropping. One of our largest exposures to white-blue light in the evening hours is a result of increased screen time. This includes both televisions and phones as well as other electronic screens. Screen time should be limited or filtered within three hours of bedtime. This melatonin suppression is not seen in the amber-red end of the light spectrum so if a night-light is preferred, find one which replicates the color of fire.
Other lifestyle changes that will improve sleep include avoiding alcohol near bedtime, establishing a regular sleep schedule, and avoiding caffeine intake after lunch.
Herbs and supplements
Combating insomnia and toning the circadian rhythm using herbs and supplements can be just as effective as pharmaceutical interventions but without some of the risks mentioned above. On the contrary, the use of many of these sleep aids will also provide side-benefits rather than side effects.
- Melatonin is a hormone that is effective in assisting the circadian rhythm balance by promoting relaxation to allow sleep to commence. Melatonin can be particularly effective for promoting sleep induction as well as treating jet lag.
- Valerian, or valerian root, is derived from the root of a flowering plant native to Eurasia. It acts as a sedative on the brain and can treat sleep disorders and anxiety. It functions by enhancing GABA and inhibiting glutamate sensitivity.
- Lemon balm, or Melissa officinalis, is an herb in the mint family that has calming effects through alterations in GABA levels. It is also known to have antiviral, antidepressant, antibacterial, anti-inflammatory, and antioxidants effects as well.
- L-theanine is an amino acid derived from tea leaves or mushrooms. It promotes relaxation via a complex interplay between GABA, serotonin, and dopamine.
- GABA is a non-essential amino acid found in the brain. Supplementing GABA levels helps induce sleep, relaxation and relieve anxiety.
- Ashwagandha is a prominent remedy used in Ayurvedic medicine. It helps alleviate insomnia by balancing cortisol levels.
- 5-HTP is an amino acid used to enhance serotonin levels in the body. Serotonin is a key neurotransmitter involved in REM sleep or dreaming.
- Chamomile tea is one of the most ancient medicinal herbs known to man. Although well known for its relaxation effects, it has also been shown to be beneficial for a variety of disorders ranging from the common cold to cancer.
A major but often overlooked cause of non-restorative sleep is obstructive sleep apnea. Once an underlying medical condition, like sleep apnea, has been ruled out, the best approach to treating insomnia would be to start with good sleep hygiene. If necessary, it could be followed by supplementation with natural agents. Medication can be considered in resistant cases of insomnia only after lifestyle modifications and natural agents have failed as well as a complete functional and conventional medicine evaluation has been completed.
Armen Nikogosian, MD, practices functional and integrative medicine at Southwest Functional Medicine in Henderson, Nev. He is board-certified in internal medicine and a member of the Institute for Functional Medicine and the Medical Academy of Pediatric Special Needs. His practice focuses on the treatment of complex medical conditions with a special emphasis on autism spectrum disorder in children as well as chronic gut issues and autoimmune conditions in adults.